Speaking at the think tank Reform's High Quality Healthcare conference in London yesterday, Dr Charles Alessi said CCGs would need to spend a lot of time ‘looking inward' if they were to succeed in transforming care.

It comes after Pulse revealed earlier this month how CCG leaders have been lobbying the NHS demanding a toughened-up system for managing the performance of practices.

Appearing in a panel debate on how to achieve quality in healthcare, Dr Alessi identified transparency, medical leadership and population health as three key issues that CCGs would need to get grips with to succeed.

When asked from the floor to comment specifically on whether new contractual terms were needed to drive up standards in GP care, Dr Alessi said the initial emphasis should be on eliminating underperformance.

He said: ‘CCG is made up of units of currency, by which I mean the practices. Unless a large amount of time is spent looking inwards to manage unwarranted variation, the success of CCGs will be limited.

‘We are on a journey. The moment we understand unwarranted variation, the discussions around terms and conditions would inevitably have to take place. But starting at that point may not be the most helpful.'

Health secretary Andrew Lansley, who also spoke at the event, echoed the sentiments. ‘We need to challenge complacency and poor performance,' he said